Capitol Tech U Doctoral Presentation - April 2024.pptx
Joint+mobility+assessment
1. Joint MobilityJoint Mobility
AssessmentAssessment
Kristofferson G. Mendoza, PTRP
Department of Physical Therapy
College of Allied Medical Professions
University of the Philippines Manila
PT 142: Assessment in Physical TherapyPT 142: Assessment in Physical Therapy
All Rights Reserved 2009
2. Learning ObjectivesLearning Objectives
By the end of the learning session, the
student should be able to:
Explain relevant concepts in joint
mobility assessment
State principles and guidelines related
to the proper use of joint mobility
assessment techniques
Identify indications and precautions as
to the use of joint mobility assessment
Given a simulated patient care
situation, interpret the results of the
joint mobility assessment
Record in an acceptable format the
findings gathered from the joint
mobility assessment
Given a simulated patient care
situation, demonstrate joint mobility
assessment techniques with correct
procedure and patient care skills
Given a simulated patient care
situation, communicate the
assessment rationale, procedure, and
results clearly and concisely
3. Review of RelevantReview of Relevant
ConceptsConcepts
Joint Mobility AssessmentJoint Mobility Assessment
4. Amount of Available ROMAmount of Available ROM
integrity of
joint surfaces
amount of
joint motion
mobility and pliability
of the soft tissues
around the joint degree of soft tissue
approximation that
occurs
amount of scarring
present
age and gender
5. Amount of Joint MotionAmount of Joint Motion
shape of
articulating surfaces
health of
surrounding tissues
health of the
joint
load-deformation
history of the joint
6. physiologic motion is limited
by a physiologic barrier
tension develops within the
surrounding tissues
(joint capsule, ligaments
and connective tissue)
7. additional amount of passive
range of motion can be performed
accessory motion can be observed
• when resistance to active
motion is applied
• when the patient’s muscles are
completely relaxed
the anatomic
barrier cannot be
exceeded without
disrupting the
joints integrity
8. = Normal Range of Motion= Normal Range of Motion
Physiologic MotionPhysiologic Motion
(Osteokinematic)(Osteokinematic)
controlled by contractile
tissues Accessory MotionAccessory Motion
(Arthrokinematic)(Arthrokinematic)
controlled by inert
tissues
++
9. Limitation of MotionLimitation of Motion
Physiologic MotionPhysiologic Motion
(Osteokinematic)(Osteokinematic)
controlled by contractile
tissues
Accessory MotionAccessory Motion
(Arthrokinematic)(Arthrokinematic)
controlled by inert
tissues
++
11. Assessment ProceduresAssessment Procedures
Pain Assessment
Active Motion Test
Passive Motion Test (Endfeel)
Passive Accessory Mobility Test (PAM
Test)
Passive Accessory Intervertebral
Mobility Test (PAIVM Test)
12. Passive AccessoryPassive Accessory
Mobility TestMobility Test
tests the accessory joint motion
determines if joint accessory motion is
hypomobile, normal or hypermobile
13. Passive AccessoryPassive Accessory
Mobility TestMobility Test
gives information about the integrity of
the inert structures
accessory motion are involuntary
muscles cannot restrict the glides of
a joint (with just a few exceptions)
14. PositioningPositioning
avoid closed-packed positions
use open-packed positions (resting
position)
or place the joint at the end of
available motion (especially the spine)
15. Use of GlidesUse of Glides
Base direction of glide on
the direction of the limited
physiologic motion and
the convex-concave rule
16. Use of GlidesUse of Glides
Perform 2 to 3 glides (ideally 1 only)
Test the unaffected extremity (or
spinal segments) first
to provide baseline information
to avoid traumatizing the patient
17. Use of Distraction andUse of Distraction and
CompressionCompression
Provides additional information as to
the structure causing the problem
Perform 2 to 3 distractions /
compressions (ideally 1 only)
18. Use of Distraction andUse of Distraction and
CompressionCompression
Test the unaffected extremity (or
spinal segments) first
to provide baseline information
to avoid traumatizing the patient
21. Hypomobility vs.Hypomobility vs.
HypermobilityHypermobility
hypomobile jointhypomobile joint
lesser movement compared to what is
normal or compared to the same joint
on the opposite extremity
hypermobile jointhypermobile joint
more movement compared to what is
normal or compared to the same joint
on the opposite extremity
25. Joint Instability vs.Joint Instability vs.
HypermobilityHypermobility
anan unstable jointunstable joint isis
different from adifferent from a hypermobile jointhypermobile joint
aa hypermobile jointhypermobile joint
hashas insufficient stabilityinsufficient stability to preventto prevent
damage from occurringdamage from occurring
but itsbut its stability is preservedstability is preserved under normalunder normal
conditionsconditions
andand remains functionalremains functional in weight bearingin weight bearing
and within certain limits of motionand within certain limits of motion
26. Joint Instability vs.Joint Instability vs.
HypermobilityHypermobility
anan unstable jointunstable joint isis
different from adifferent from a hypermobile jointhypermobile joint
anan unstable jointunstable joint
involvesinvolves disruptiondisruption of theof the osseousosseous andand
ligamentous structuresligamentous structures of that jointof that joint
resulting toresulting to loss of functionloss of function
27. Interpreting GlidesInterpreting Glides
If the joint glide is unrestricted
integrity of both the joint surface and
the periarticular tissue is good
the patient’s loss of motion must be
the result of contractile tissue
intervention: soft-tissue mobilization
28. Interpreting GlidesInterpreting Glides
If the joint glide is unrestricted and excessive
excessive motion may indicate:
pathological hypermobility
instability
may be normal for the individual
intervention:
stabilizing techniques to support the joint
through muscle action and
mobilization of hypomobile neighboring joint
29. Interpreting GlidesInterpreting Glides
If joint glide is restricted
LOM is caused by the joint surface and
periarticular tissues (but contractile
tissue may still be affected)
intervention: joint mobilization
once intervention is done,
osteokinematic motions are assessed
again. if movement is still limited then
the muscles are at fault
30. Interpreting DistractionInterpreting Distraction
if distraction is limited, it may indicate
a contracture of connective tissue
if distraction increases pain, it may
indicate a tear of connective tissue and
may be associated with increased
range
if the distraction decreases pain, it
may indicate an involvement of the
joint surface
31. Interpreting CompressionInterpreting Compression
if the compression increases pain, a
loose body or internal derangement of
the joint is present
if compression decreases pain, the
joint capsule may be affected
34. Thank YouThank You
PT 142: Assessment in Physical TherapyPT 142: Assessment in Physical Therapy
Joint Mobility AssessmentJoint Mobility Assessment
Kristofferson G. Mendoza, PTRP
kmendoza.ptrp@yahoo.com
All Rights Reserved 2009